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Wednesday, 22 January 2014

Why Couples Have Trouble Having Another Child

•Its Called Secondary Infertility


Secondary infertility is defined as the inability to become pregnant or to carry a pregnancy to term, following the birth of one or more biological children. The birth of the first child does not involve any assisted reproductive technology or fertility medications

Secondary infertility shares many of the same causes of primary infertility. Sometimes secondary infertility stems from complications related to prior pregnancies, changes in you or your partner risks factors such as age, weight and the use of certain medications can also contribute to secondary infertility. Secondary infertility can be surprising and very stressful.


Infertility is defined as a disease or condition of repr
oductive system often diagnosed after a couple has had one year of unprotected, well timed intercourse, or if the woman has suffered from multiple miscarriages. Infertility is a medical problem. Secondary infertility accounts for 60% of all infertility cases. 40% of infertility is due to female factor and 40% is due to male factor.


You should not be concerned unless you have been trying for at least one year and you are over 35 and have been trying for 6 months you should see a specialist. If you are over 30 years and have a history of pelvic inflammatory disease (PID), painful periods, miscarriage, irregular cycle or if you know your husband or partner has a low sperm count, do not wait for one year before consulting a specialist.


When your first child is conceived with so much ease, you may feel completely off guard by the difficulty of having a second child. Take charge of the situation by talking to your gynaecologist. Secondary infertility is very common but not often talked about.


Many doctors may down play the possibility of secondary infertility in their previously fertile patients and encourage the couple to ‘’keep on trying’’. The emotional experience of secondary infertility often is a compilation of the distressing feelings of anger, grief, depression, isolation, guilt, jealousy, self blame and being out of control. There may be guilt for experiencing normal grief and worry about how your current emotional state will affect your existing child.

Powerlessness to produce a sibling for the existing child often produce feelings of sorrow as does the inability to perpetuate the parenting role.

Sadly, couples with secondary infertility tend to receive less social support from others than couples who have primary infertility because infertility is invisible as the couple has a child, and there is no concrete loss in the family.

Couples with secondary infertility may also be recipient of criticism by others who think they should be grateful for one child and that it is foolish to go extremes to increase their family size.

Guilt about not providing the existing child with a sibling is a common experience of couples suffering from secondary infertility, as they feel that they are failing their child.

The other danger to the existing child is that the parents may become overly protective and too attentive to the existing child. In the face of loss they want to hang on to what they have and love. These parenting feeling must be kept in balance with the growing child’s needs for separation and independence.


The resolution of secondary infertility brings with it many variables into the decision making process. Couples often need assistance from professionals and support groups if available as they struggle with the turmoil of secondary infertility. The ultimate goal in secondary infertility is

(1) Grieve the loss of a wanted child that refuse to come,

(2) Decide to pursue medical or assisted reproductive treatment or

(3) Alternative family building options such as adoption or

(4) Embrace the established family as it exists with resolution comes the reclamation of life.


If you already have one child, you know you are fertile and will have no problems conceiving again.


Infertility does not discriminate and can strike anyone at anytime throughout the child bearing years. Secondary infertility is very common and it accounts for about 60% of all infertility cases.

Unlike those experiencing difficulty having their first child, people who are affected by secondary infertility are much less likely to see infertility treatment. Many in this situation are told that they have nothing to worry about, to just keep trying. This can lead to much frustrations and loss of precious time.

A number of things can cause secondary infertility, including age, damage or blockage of the fallopian tubes, ovulation problems, endometriosis, and problems with sperm production. The testing and diagnosis process is the same as for primary infertility.


The diagnosis of secondary infertility can be emotional and very difficult. Couples that are experiencing secondary infertility are reluctant to reach out to others and may feel like they are already blessed with one child and should be happy with that.

The investigation working in secondary infertility should focus more on specific factors that have changed with you or your partner since having your first child.

Infertility treatment is focused on the specific cause of the problem and reviewing your recent history is very important in making a diagnosis.



The mothers’ age is one of the most common reasons for secondary infertility. Couples often delay trying for another child because they believe that conception will occur without difficulty. The natural decline in ovarian function is the single most important factor in fertility. It is important to realise that women are born with all of the eggs they will ever have. As a woman ages, the egg quality decreases and the chances of miscarriage increases. Men however produce new sperm every day.


Sexually transmitted disease, endometriosis and a history of ruptured appendix can lead to pelvic adhesions that interfere with the ability of the egg to be picked up by the fallopian tubes.

For example if there were complications during a prior delivery and a woman developed uterine infection or if she underwent a difficult pelvic surgery she may be at risk for a condition known as ashermans syndrome. (Intrauterine adhesions) or adhesions around the fallopian tubes which prevents tubes from capturing the ovum during ovulation.


Changes in sperm quality or quantity may occur due to changes in health or beginning certain new medications. Indiscriminate use of testosterone supplementation prescribed or bought over the counter by men may decrease sperm production dramatically and can often take up to a year to get back to normal after stopping medications.


Factors such as weight can have an impact on the ability to conceive. Excessive weight contributes to ovulatory disorders. As a woman’s weight increases, insulin resistance also increases leading to elevated production of male hormones such as testosterone which affects ovulation. For men, excessive weight gain can increase Male oestrogen levels which can negatively affect sperm production. Cigarette smoking can also impact egg quality.

Fertility medications and injectables are used to increase the number of eggs available for feritilization either naturally or with intrauterine insemination or invitro fertilization.

Current treatment has improved dramatically thus encouraging couples to seek help in overcoming secondary infertility challenges.

The pregnancy rate for couples using assisted reproductive technology (ART) now exceeds the monthly fertility rate for couples without fertility problems

Dr Tunde Okewale,Consultant O & G, Fertility Expert, St Ives Hospital, 12 Salvation Road Opebi, Ikeja, 6 Maitama Sule Street, Ikoyi , Lagos,,, 07088727358, 08101688093.

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